FOREWORD 17 



The technique of administration is simple. It is well to steri- 

 lize the patient's skin by touching the point of injection with 

 Tincture of Iodine and then with Alcohol. Touch the neck of 

 the ampule with a file, and it may readily be broken. Insert a 

 sterile hypodermic needle and withdraw the amount of the in- 

 tended dose. A partially used ampule may be resealed by touch- 

 ing the neck immediately to a drop of melted sealing wax. If 

 contaminated, the extract becomes an excellent culture medium 

 and must, of course, be discarded. 



The initial dose of any Proteal is from three to five minims. 

 Repeat this daily or on alternate days until three or four doses 

 have been given. Thereafter, if there has been no severe reac- 

 tion, increase the dose by one or two minims with each adminis- 

 tration until a satisfactory dosage is established for the particular 

 case in hand. 



The maximum dose varies with individual cases and with dif- 

 ferent maladies. 



In anaemias, intestinal toxaemias, asthma, and tuberculosis, 

 optimum results have been attained with a maximum dose of five 

 to ten minims, administered on alternate days for a more or less 

 protracted period. Obstinate cases of psoriasis have yielded to a 

 similar dosage. 



With rheumatic conditions, and especially rheumatoid arthritis, 

 on the other hand, it is usually desirable to advance to a dosage 

 of fifteen or twenty minims at least; sometimes to twenty-five 

 or thirty minims, administered on alternate days or even daily. 



Maximum doses and frequent administration are usually de- 

 sirable, also, to get optimum and cumulative results, in cases of 

 cancer, particularly where the neoplasm is large. 



The blood count furnishes the best guide to dosage in admin- 

 istering the Proteals. The Proteal response is essentially a 

 blood reaction. The ideal is to bring the haemoglobin to approxi- 

 mately normal ; the red corpuscle count to normal or supernor- 

 mal; and the average leucocyte count to seven or eight thou- 

 sand, with the differential count showing polynuclears relatively 

 low, and large mononuclears advancing to high supernormal ten, 

 fifteen, or twenty per cent, of the total. 



Where the blood count is not available, clinical symptoms 

 must, of course, furnish a guide to dosage. It goes without 

 saying that the administration of the Proteals gives opportunity 

 for the exercise of skill and judgment on the part of the prac- 

 titioner. The response and the needs of each individual patient 

 should be carefully studied, as in the administration of any other 

 line of scientific treatment. 



A change of Proteals from time to time is essential in the 

 treatment of most protracted cases, in order to secure cumulative 



